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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Cerebral Palsy
Sub-Domain: General Health History
CRF: Vaccination History
Item count: 5 (5 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C22793
Vaccine history report informant specify type
VaccHxRptInformSpcfyTyp
The type of informant the vaccine history report was collected from
Report obtained by:
Other specify;Parent;Physician;Record Review;Self;
Other specify;Parent;Physician;Record Review;Self;
Alphanumeric
Choose all that apply.
No references available
Pediatric
Supplemental
1.0
10/28/2016
Aliases for variable name not defined
Vaccination History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C16187
Vaccine type
VaccTyp
Vaccination received by pediatric patient
Vaccine
Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine;
Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine;
Alphanumeric
For each vaccine type record whether the participant/subject received it and if he/she was hospitalized following the vaccination.
No references available
Pediatric
Supplemental
3.0
6/11/2013
Aliases for variable name not defined
Vaccination History
General Health History
Participant History and Family History
Vaccine type
 
Single Pre-Defined Value Selected
       
C22792
Vaccines received indicator
VaccineRcvInd
Indicates whether participant/subject received the vaccine.
Did patient receive this vaccine?
Natural infection, specify age;No;Not Asked;Unknown;Yes;
Natural infection, specify age;No;Not Asked;;Yes;
Alphanumeric
Answer, choosing one. Record from vaccination record where possible. For vaccines which require more than one immunization, yes refers to completion of all immunizations required for participant/subject’s current age.
No references available
Pediatric
Supplemental
1.0
10/28/2016
Aliases for variable name not defined
Vaccination History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C16191
Chicken pox infection age value
ChickenPoxInfctAgeVal
The age value of participant/subject when they experienced a natural infection of chicken pox.
Natural infection, specify age
  
Numeric Values
Record age in years
No references available
Pediatric
Supplemental
3.0
6/11/2013
Aliases for variable name not defined
Vaccination History
General Health History
Participant History and Family History
Chicken pox infection age value
 
Free-Form Entry
  
year
    
C16189
Vaccine hospitalization indicator
VaccineHosznpInd
Indicates whether participant/subject was hospitalized due to serious complications from vaccine
Hospitalized?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
Answer for each vaccination type. Choose one. If yes, specify.
No references available
Pediatric
Supplemental
3.0
6/11/2013
Aliases for variable name not defined
Vaccination History
General Health History
Participant History and Family History
Vaccine hospitalization indicator
 
Single Pre-Defined Value Selected
       
07-20-2019
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